JessicaLopezFlores_Policy_Paper_PM508
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“HEALTHCARE: A RIGHT OR LUXURY?”
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“Healthcare: A Right or Luxury?”
Jessica Lopez Flores
University of Southern California
PM 508: Health Service Delivery in the U.S.
Dr. Sue Kim
November 14, 2023
“HEALTHCARE: A RIGHT OR LUXURY?”
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In the United States the question: “Should the government guarantee access to free or subsidized health care services for anyone in the U.S.?” has been a contentious and polarizing topic. Those in disagreement claim that it is not the U.S. government’s responsibility to provide access to free or subsidized care but rather that of the citizens. That said, those in favor claim that
access to healthcare is a human right and should be extended to anyone regardless of their status. This debate has left the nation divided for several years impeding the progression of a new policy
that addresses this issue and is affecting the well-being of thousands of U.S. residents. This paper
will elaborate on the benefits of having access to health care for all, and policy criteria will be discussed in accordance with the new healthcare policy along with the expansion of existing health policies. The exploration of the implications of Public Health in the delivery of healthcare in the U.S. will be scrutinized and applied to the new health policy.
The absence of adequate health care is a serious matter. According to researchers, “more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care” (Galvani et al., 2020). This is a concerning issue that is affecting a large part of the U.S. population. These findings reinforce the argument in favor of a health care policy where
people are not only impacted by the lack of health insurance but also by the inaccessibility of adequate healthcare. Also according to researchers, “the uninsured have poorer health and shortened lives” (Michael McWilliams, 2009). Those without health insurance will have to bear the out-of-pocket costs of care that would be otherwise covered through health insurance. Individuals in lower socioeconomic statuses cannot afford the high costs of healthcare, leaving preventable and treatable diseases such as diabetes to go untreated until the disease has progressed beyond remedy. “Patients from a lower SES had an increased prevalence of diabetes and had greater adherence to preventive healthcare measures. However, they were less successful
in meeting target treatment goals” (Jotkowitz et al., 2006). Researchers found that low SES
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patients received more preventable care than those in a higher SES but had worse results. In the discussion researchers commented on the possible reasons for these results, which include “financial means to follow provider recommendations, and lifestyle differences along with physician factors such as bias.” (Jotkowitz et al., 2006). In this case, following provider recommendations can indicate that the patient may not have the funds necessary to follow treatment such as medications and other procedures, or the health literacy to adhere to the physician’s orders.
Without any preventative health policy set, communities will continue to remain affected.
As mentioned before, inaccessibility to health care can lead to detrimental health problems. Researchers not only found that uninsured Americans receive delayed treatment and have a higher morbidity rate but also receive poorer care even from acute diseases and conditions. “Working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the
hospital, even for acute situations like a motor vehicle crash” (
Care without coverage too little, too late
2002). The implementation of a preventative health policy that provides adequate access to healthcare is a crucial public health issue. There is a dire need for health care reform, where the lack of adequate health care and health insurance has detrimental effects on the lives of thousands of Americans every day. With a healthcare reform, health equity among disadvantaged
individuals should be addressed and prioritized. The purpose of this reform is to guarantee quality care for everyone regardless of socio-economic status, immigration status, and more.
While many states have opposed the Affordable Care Act (ACA), California’s Medi-Cal program was expanded to provide coverage to more of its residents, increasing coverage to those in the 138% poverty level (DHCS.CA). Medi-Cal is California’s Medicaid program that provides
health coverage for its low-income residents (Chapman & Pellón, 2023). Medical funding is
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broken down from several different funds, including federal, state, and general. Precise numbers are as follows: “70% by the federal government, 21% from the state general fund, and 9% using other state and local funds” (Chapman & Pellón, 2023). Medi-Cal has provided care to thousands
of its California residents who do not have health insurance due to varying reasons, such as, unemployment, disability, immigration status. California also signed a policy into law in May 2022 called the Older Adult Expansion program, granting access to healthcare to every adult over the age of 50, regardless of their immigration status (DHCS.CA). This policy was modeled after the Young Adult Expansion, which expanded Medi-Cal coverage to young adults ages 19 to
25 (DHCS.CA). While the criteria for Medi-Cal eligibility remains the same through these policies, more California residents are covered through these programs and cannot be denied based on their immigration status. Another new policy that has been signed is to go into effect on
January 1, 2024 called “Ages 26 through 49 Expansion” (DHCS.CA). Like the other expansion policies, this policy provides coverage to adults ages 26 through 49 regardless of their immigration status. This expansion initiative was created by Governor of California, Gavin Newson, to provide coverage to all residents of California, including the undocumented population, who make up “more than 6% of the state’s population” (Hayes & Hill, 2023). These new policies provide healthcare coverage to this vulnerable population and allows them to receive the preventative care and treatment they do not have access to. Though California is the first and only State that has implemented these new laws, it is of crucial importance that this policy reaches other states in the U.S, where 3.2% of the nation’s population is made up of undocumented immigrants (Hayes & Hill, 2023). That is 10.5 million of people who do not have access to free or subsidized care due to their immigration status. Though the Affordable Care Act
provided healthcare coverage for millions of Americans, this did not include undocumented immigrants.
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The issue of free or subsidized access to healthcare continues to be a polarizing issue in the U.S. Many are divided between the two sides, with one side stating that it is the citizens’ responsibility and the other claiming that it is a basic human right, and no one should be denied care regardless of their socioeconomic status. Laws that have been set in place like the Affordable Care Act, that came into effect during the Obama administration in 2010, and has been a source of conflict between political parties. The ACA was implemented with the purpose of providing affordable care coverage to all Americans (Roland, 2019). The ACA implementation had promising results with “more than 16 million Americans obtained health insurance coverage within the first five years of the ACA (Roland, 2019). The ACA guidelines allowed millions of Americans to gain access to healthcare resources that they didn't have before due to reasons such as unemployment, low-paying jobs, disabilities, and family obligations (Roland, 2019). These changes alleviated the burden of healthcare inaccessibility for millions of Americans. With this new policy, Americans were able to receive the preventative screening necessary for a healthier life. The ACA “covers many screenings and preventive services” (Roland, 2019). With screening and preventative services provided at a free or low cost, patients can receive adequate care and treatment in time before their conditions worsen, ensuring the prevention of the disease. This measure helps provide health equity to communities that do not have the adequate resources to seek care. The lack of health equity among minority communities is a prevalent issue that is still to be resolved. While there are changes made provided by the ACA, many are still left uninsured due to qualifying factors set in place by their state of residence.
While there are many benefits to the ACA, there are also downsides. Though the ACA guarantees health coverage to millions of Americans, those who already had their own health insurance, experienced an increase in premiums. The reason for this is through the ACA,
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insurance companies cannot deny coverage due to pre-existing conditions. As a result, “insurance companies now provide a wider range of benefits and cover people with preexisting conditions” (Roland, 2019). This increase in premiums has caused controversy among private health insurance consumers. Where relatively healthy individuals must pay a high premium for coverage they don’t need.
As mentioned previously, the ACA was the source of conflict between states. Shortly after the law was signed, “26 states filed lawsuits challenging key provisions” (Lanford & Quadagno, 2015). Their claim was that this was unconstitutional and should not apply to all states. This lasted for 2 years when the Supreme Court “ruled in support of most provisions but held that the mandatory Medicaid expansion was unconstitutional, in effect making it optional for the states” (Lanford & Quadagno, 2015). This case was the Supreme Court case National Federation of Independent Business v. Sebelius in 2012. The Supreme Court ruled for the opposing states in 2012 but still required them to implement Medicaid expansion, which was a federal and state program that provided healthcare coverage for low-income families. Opposing states with Republican governors claimed that this would create a financial burden on the state.
One of the arguments used by the opponents of the ACA was that this would ruin the job market.
Through the ACA “Business with 50 or more full-time employees must offer insurance or make payments to cover healthcare expenses for employees” (Roland, 2019). Adversaries theorized “By reducing hours, businesses are able to get by the 30-hour-per-week definition of a full-time employee” (Roland, 2019). This is to avoid the legal responsibility of providing health insurance to their employees. This would, in theory, cause an increase in federal spending because the number of uninsured would increase. While there are reports of some businesses cutting hours, “the number of full-time jobs has gone up in recent years” (Roland, 2019). This is evidence that the ACA has not damaged the job market, as opponents had theorized.
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The U.S. has the highest spending for healthcare in comparison with other developed countries. According to Dalen, “we pay more for health care than any other country in the world;
yet our health outcomes are below that of other western nations” (Dalen, 2010). One of the reasons why the U.S. has worse outcomes is due to the lack of adequate access to health care. A study claims the high morbidity rates among uninsured is due to “access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance” (Wilper et al., 2009). The uninsured people in these communities do not receive the same level of care compared to those who have access to a private health insurance. Due to their lack of health insurance, they must resort to community clinics that are not equipped with the resources necessary to treat these patients. Health equity is an important issue to be addressed, with a healthcare-for-all policy, those with a low socioeconomic status would have access to the same level of care as someone with a higher socioeconomic status.
In the proposal of a healthcare policy, it is important to analyze current ones, and see what can be changed to provide the best health outcomes. Using California’s healthcare expansion laws that have been set recently, Medi-Cal coverage has been expanded to undocumented immigrants who have been excluded from all healthcare coverage policies in the past. According to a study, “systems that enhance the provision of primary health care are associated with better overall mortality rates” (AIM, 2008). The idea behind this model is to prevent the progression or diagnosis of preventable and treatable diseases. With this policy, yearly physicals will be set in place for screening of common diseases. This is to ensure the early
diagnosis and treatment of such diseases. Though this is a policy that is in action in California, the goal is to eventually have all 50 states approve and adopt this policy. There is no current data on how this policy has been benefiting California residents since it is new.
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There are many limitations to this proposed policy. One of the main issues would be compliance. The requirement to be eligible for this health care coverage policy is that you must comply with yearly physicals. To incentivize this method, there will be bonuses available to providers who complete a yearly physical for at least 80% of their patients. Another issue that will be faced is federal funding. As mentioned previously, universal healthcare coverage is a polarizing issue that many states are against. Though California is the first state to pass a policy like this, it is going to be difficult to get other States to adopt and implement this new policy.
In addressing the criteria for the beneficiaries of this new healthcare policy and assessing the standards at which adults and children will be held, there can be some complex inquiries. This is where many will face a moral dilemma, but this policy will focus on prevention and health promotion rather than disease management. Keeping the same criteria from the Medi-Cal expansion plan where people age up to 65 with a 138% poverty level qualify. Those above would be a part of the Medicare program available to people 65 and older. In addition to this criterion, to receive coverage through this policy, you are mandated for yearly physicals at your physician of choice. Along with the screening for Diabetes, Hypertension, High Cholesterol, Kidney, Liver and Heart disease etc. This is modeled to diagnose and treat the disease before it progresses and have dire consequences. Alternative policies that have also been suggested by researchers, which include Medicare Extra for all and Medicare part E. In Medicare Extra will provide coverage to “Ill legal nonelderly U.S. residents are automatically enrolled in Medicare Part E unless they have comprehensive employer-sponsored coverage or Medicaid. Undocumented immigrants would not be eligible for Part E coverage.” (Crowley et al., 2020). One of the downsides to this policy is that it will not provide coverage to undocumented immigrants. Something that is important and implemented into the suggested policy above. Medicare Extra for All coverage will be provided “for all lawfully residing Americans over a
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period of 8 years from enactment” (Crowley et al., 2020). With this policy, anyone under the age
of 65 that does not have coverage, will be automatically enrolled. Coverage will last up to 8 years and premium costs will depend on annual salary.
In the United States the question: “Should the government guarantee access to free or subsidized health care services for anyone in the U.S.?” has been a contentious and polarizing topic. Creating a policy that eliminates health disparities and works towards the best outcome for
all its beneficiaries can be difficult. In this policy, the combination of healthcare coverage for everyone, regardless immigration status, and a preventative health model, one can address current health disparities and provide health equity for all. Creating a healthcare model that incentivizes better health outcomes through health education and accessibility to resources is necessary to bring about change to the current U.S. healthcare system.
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